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Esophageal dilatation
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Jennifer Billington, Niyi Ade-Ajayi
Devices for dilatation may be put into three broad categories: Bougies, balloon dilators, and stents. Bougies can be subdivided into those that are passed over a guidewire and those that are not. They come with a range of different tips: Blunt, conical, olive-tipped, and tapered. Stents are divided depending on material (metal or plastic) and whether or not they are covered (Tables 5.2 and 5.3).
Benign oesophageal obstruction
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
Lubricating jelly is applied to the tapered segment of the bougies. Dilatation is achieved by the successive passage of progressively larger dilators through the stricture. For very tight strictures, it is advisable not to attempt full dilatation in a single session. Benign strictures which can be traversed by a 10-mm endoscope can normally be safely dilated to 18 mm in a single session.
Complex lower extremity revascularization
Published in Peter A. Schneider, Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
There are several issues with highly calcified lesions that should be considered and some maneuvers that can help work one’s way around them. Highly calcified lesions pose the risk that the calcium will not give way and the lesion can be pushed through the arterial wall if dilated too aggressively and all at once, causing potentially a localized or free rupture. The other risk is that the lesion may be recalcitrant to dilation and it may not be possible to gain an adequate lumen. In order to avoid this scenario, the lesion could be gradually dilated to ensure that a lumen is created. Cutting or scoring balloons can also be used in this situation. If a patient is experiencing severe pain with dilation, it usually makes sense to permit some degree of residual stenosis rather than attempting to achieve a perfect cosmetic result. When it is likely that a residual stenosis will be present, it is often not possible for a balloon-expandable stent to oppose the wall both proximal and distal to the location of the lesion. In this setting, a self-expanding stent with continued gradual and stepwise poststent dilation at the location of residual stenosis could be used.
Factors associated with the efficacy and safety of endoscopic dilatation of symptomatic strictures in Crohn’s disease: a retrospective cohort study
Published in Scandinavian Journal of Gastroenterology, 2023
Pierre Dandoy, Edouard Louis, Pierrette Gast, Maxime Poncin, Laurence Seidel, Jean-Philippe Loly
Our study showed that in patients with stricturing disease, 53.2% of dilated patients had to undergo further dilation, with the disease remaining unchanged and not progressing to a penetrating form or regressing to a non-penetrating, non-stricturing form. An interesting study by Louis et al. carried out on 297 patients treated in our university hospital in Liege, evaluated the evolution of the location and of the behavior of CD over time. It was shown that after 25 years of follow-up, few patients who initially presented with non-penetrating and non-stricturing disease (corresponding to stage B1 of the Vienna classification) kept an uncomplicated disease. Indeed, 25–33% of patients develop stricturing or penetrating disease every 5 years. For patients developing stenosis, a minority will eventually progress to penetrating disease: indeed, 78% of patients who have progressed to stricturing disease will remain so after 6.5 years of follow-up. Moreover, 88% of patients diagnosed with a stricturing CD (B2 according to Vienna classification) will remain so. Finally, they also showed that out of 31 patients with stricturing disease, 7 developed penetrating disease after stenosis surgery while 24 kept their stricturing disease (median follow-up of 8 years). This corroborates the fact that, even though iterative dilatations are carried out to relieve the patient for a variable duration, which could be extended by using larger balloons as suggested above, the behavior of stricturing CD remains the same.
Choice of anesthetic technique for dilation and curettage for indication of pregnancy loss
Published in Baylor University Medical Center Proceedings, 2022
Alexandra Carlson, Jessica C. Ehrig, Kendall Hammonds, Michael P. Hofkamp
Miscarriage is the loss of pregnancy before viability, and it is estimated that 23 million miscarriages occur each year throughout the world.1 The management of loss of pregnancy is broadly divided between expectant, medical, and surgical treatment options, and dilation and curettage is one surgical treatment option for pregnancy loss.2 The choice of anesthetic technique for dilation and curettage depends on operative indication, patient comorbidities, and the preferences of the patient, anesthesia provider, and obstetrician. Patients at our hospital who have dilation and curettage for miscarriage have either general anesthesia or deep sedation. Our primary aim was to determine the difference in estimated blood loss between dilation and curettage performed under general anesthesia and deep sedation, and our secondary aim was to identify which patients at our hospital received general anesthesia for dilation and curettage. We hypothesized that patients at our hospital who received general anesthesia as the initial anesthetic technique for dilation and curettage for loss of pregnancy during the first or second trimesters would have a higher estimated blood loss, a higher body mass index, and a later gestational age compared to patients who received sedation for the same procedure.
Pneumatic dilation for esophageal achalasia: patient selection and perspectives
Published in Scandinavian Journal of Gastroenterology, 2022
Abdul Mohammed, Rajat Garg, Neethi Paranji, Aneesh V. Samineni, Prashanthi N. Thota, Madhusudhan R. Sanaka
After successful dilation, the patient is positioned in the left lateral position to minimize aspiration before the balloon is deflated and removed. The guidewire is left in place while a repeat endoscopy is performed to assess the degree of mucosal tear. In the absence of significant procedural complication, the endoscope and the guidewire are removed. Dilation is achieved in a graded fashion, starting with 30 mm and progressing to larger diameters (35 mm and 40 mm). The need for a repeat dilation is assessed based on symptom relief with repeat LES pressure measurements [23,24] or improvement in esophageal emptying in 4–6 weeks (Figure 3) [19,25]. PD is considered a failure only if there are persistent symptoms despite 40 mm dilation. Several different PD protocols have been described in the literature with varied efficacy. The summarized results of 10 studies are shown in Table 1. Dilation with 30 mm and 35 mm showed comparable mean remission rates after 6 months (81% and 79%), while dilation to 40 mm had a higher remission rate of 90%. After 12 months, the rates declined to 77%, 70%, and 87% [26]. In our practice, we perform follow-ups per the recent ACG guidelines. We monitor patients for symptomatic and objective improvement 4–6 weeks after PD. In patients without symptomatic or objective improvement, we proceed with the next size dilation [27].